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Wednesday, April 11, 2018

Quality Story Telling - take 1: An additional cost for quality??

There are many paths that lead
to Medical Laboratory Quality Improvement; education conference and study,
implementation of innovative programs, and working at the level of personal
responsibility and in particular building a strong positive organizational
culture that supports and promotes quality thinking.In our course we put a lot of emphasis of
highlighting all these approaches, and we do it through the process of
storytelling, which is the way that adult learners share their experiences in a
way that others pick on new insights.

Storytelling can benefit both the story teller and the story listener. It is a great way to communicate and learn all at the same time.

So let me tell you a story.

The other day I was in a
discussion with a person with a lot of responsibility for laboratory activities
in our province.We were talking about
our province’s on-line reporting system for medical laboratory error, in part
because of the two recent manuscripts that I and colleagues have recently had
published on the subject.

This provincial reporting system (the BC
Patient Safety Learning System or PSLS) is now about 10 years old, and suffers many of
the problems of most 10 year old software; that being said, the system has far
more positives than negatives and provides us with a lot of information and
insights on the state of laboratory quality efforts in British Columbia.

It is a volunteer program
where the reporter identifies a problem and goes to the on-line site and
completes a reporting.Sometimes, the
same event can be reported by more than one person, each from their own
perspective.Sometimes an event that
people wanted to report does not get reported because it was inconvenient at
the moment to stop and report, and then people forgot or got otherwise
distracted.

Error reporting is not particularly
balanced; there are some profession groups and some geographic parts of the
province that are likely to report events and other seem to have little
interest, and that was the topic of our discussion.

So I was having this
conversation and this person came up with two comments the first was that the
system is not helpful or user friendly because a laboratorian would have to
take 5 minutes to complete an on-line report, and that laboratory physicians
are far too busy to stop and take the required 5 minutes just to report an
error.

In this person’s mind consuming 5
minutes of their valuable time was some sort of terrible imposition that way
overrides the systemic benefits of reporting errors.As personal conviction, reports should not be
entered until PSLS spends the money to revamp the software so the events can be
entered in less time, caving these poor overworked souls 2-3 minutes a
day.Regardless of costs, their time constraints demand it.

But then they went further;
the reason that people don’t report is because there is no financial incentive
to participate and report.

Rather than pursue the
conversation I decided to change the topic.If what I thought was being said was indeed being said, our discussion
would have turned into an ugly confrontation that would have benefited no
one.Surely nobody with a modicum of
quality awareness thinks that the best way to enhance error reporting is to pay
people to report.What could possibly go
wrong with that idea!!

In actual fact, the data in
the two manuscripts points to the fact that this person was wrong.Over the years, the rate of error reporting has
gone up substantially.It seems that
increasingly people are using they system, despite what slight software inconveniences
exist. The system probably could be enhanced,
tweaked, to make it a little more user friendly, but major overhauls would cost
a ton and likely introduce all sorts of interface problems with not much benefit
towards reporting.

If we need to do something it
is to work with the groups who choose to not report and find solutions to the
barriers. I suspect it is probably
something as simple as being unaware, or “fear of the learning curve”.I suspect it is more about habit than
conviction.And I suspect it has NOTHING
to do with people begrudging the couple of minutes to report.(By the way, if a laboratorian is having to
report more than 2-3 errors a week, costing them more than 15 minutes there is
something going on that needs a lot more attention.

The evidence to date is that
reporting errors has a lot to do with quality awareness, and personal
conviction and growth that comes with quality activity.

Reporting progress does not need BIG thinkers,
it needs engaged thinkers who see value in spending a few minutes to initiate a
report and implement a corrective action.

But if it requires extra MONEY to support a pay-for-reports program,
then we are really in trouble.